White Coat Hypertension and OSA - any experts?

Captain_Midnight · Post by **Captain_Midnight** » Mon Oct 30, 2006 11:53 pm

I've been successfully doing CPAP therapy for about 11 months, and most of my health-related symptoms due to about 40 years of undiagnosed OSA have gone away. CPAP is a true miracle machine for me.

I really only have one symptom remaining, white coat hypertension. Ugh.

White coat hypertension is where an otherwise strong guy like me gets a little antsy in the Dr's office, and my b.p. readings are artificially high. (At home, my weekly readings are consistently below 120/80, pulse just below 50 which is about right for a distance runner.)

And what this really means is that I'm taking an HBP med that I may not need to take.

The apnea connection to WCH is well-established, for example, at this site... http://www.scienceblog.com/community/ol ... 4258.shtml

My question for this learned forum is this. What is the best advice for a nice, low (but valid) b.p. reading in the Dr's office? In an earlier thread I picked up some useful pointers, such as letting the nurse support my arm, and keeping the elbow bent. Also, to regulate breathing. Any others?

Thanks in advance!

Hi regards all - - Captain Midnight

Snoredog · Post by **Snoredog** » Tue Oct 31, 2006 12:40 am

my daughter is a dentist, I don't know if it is her or that white coat syndrome but my BP always jumps up when in doctors office. I just took it a bit ago and it was 113/78. When she takes it, she even makes me uncross my legs if they are crossed, if it is found high I catch it big time, She is worse than any doctor I've had when it comes to hypertension, she really rags on me more so than her average patient. I say it is controlled she disagrees, I've resorted to taking my own BP monitor in with me and showing her the prior 30 readings where it is normal. Once I've even taken an extra lisinopril before going in to see her. Then I sit in the chair all dizzy with vertigo from hypotension.

OwlCreekObserver · Post by **OwlCreekObserver** » Tue Oct 31, 2006 4:23 am

I've always had borderline high pressure readings, especially during medical appointments. During my Air Force career, some genius decided that a good time to check everyone's BP was during their annual dental exam. Oh yeah, no chance of elevated numbers there!

I'm now on very low dose meds, but that's because every time I see my doctor, I take along a spreadsheet summary of my previous 30 days pressures. If he based my medication on the readings during my office visits, I'm sure the dosage would be much higher. Recording the numbers every morning may seem a little excessive (obsessive? Compulsive?) but at least I feel like my doc is getting enough good information to make good decisions.

OCO

greyhound · Post by **greyhound** » Tue Oct 31, 2006 5:21 am

I've got the same problem - borderline high systolic blood pressure. My doctor encourages me to take multiple readings and to bring them in to him. He bases my treatment (no medication) on the distribution of the bp readings that I've kept.

wading thru the muck! · Post by **wading thru the muck!** » Tue Oct 31, 2006 6:38 am

I also have this. My current Doc let's me record my own at home and then use that as what he wries on my chart. If your Doc is not so trusting you can get a recording blood pressure monitor that you wear around like a bracelet. It will record your BP during your normal daily activity and give a much more "real" picture of your BP.

tmaiberger · Post by **tmaiberger** » Tue Oct 31, 2006 6:40 am

I am the same as greyhound. The only reason that I am not on meds for HBP is that I track it on charts my dr gave me (column for date, systolic, diastolic and I made one for pulse since my BP monitor shows that as well). She has told me for the past three years that without the charts she would have to put me on meds. The other thing she does when I have my physical is to retake the BP after about 20 or 30 minutes and each time it has significantly lowered (still a bit high, but not throught the roof).

greyhound · Post by **greyhound** » Tue Oct 31, 2006 6:55 am

That's interesting. My doctor occasionally retakes my blood pressure at the end of my visit. Invariably, it's significantly lower than the first reading.

tmaiberger · Post by **tmaiberger** » Tue Oct 31, 2006 7:59 am

My doctor said that in her opinion the second reading is a more accurate indication of the normal BP, because she has found that people who have elevated BP primarily at the dr office tend to relax once the exam is underway. Still, my BP is on the high side of normal so I still need to exercise more, lose weight and watch diet to try to prevent it from creeping even higher (a neverending struggle it seems)

TM

krousseau · Post by **krousseau** » Tue Oct 31, 2006 9:09 am

Having your own BP monitor and taking readings at home is the best way to get an accurate picture of what your BP runs. Take it in the AM before you get out of bed some days take it at mid-morning noon, mid-afternoon, before supper, after supper, before bed. Take it when you are busy-take it when you are relaxed. Take it while watching the evening news or watching a low key movie. What you learn is 1) that the BP naturally fluctuates quite a bit 2) it usually fluctuates around a set of fairly consistent numbers 3)higher when excited, angry, anxious, emotional, 4) lower when relaxed. That level where your BP usually sits is your baseline BP. If you have a lot of stress and you are up from baseline a lot-you want to do something to control the stressors that boost it. If you can't reduce the stressors OR YOUR RESPONSE TO THEM medication for the stress response or the BP may be needed.

Forget that it is only white coats that produces that reaction for us. Think about whether or not you respond that way to many of life's minor worries & events-are you vigilant about things around you-or reactive to things that happen . If yes your BP could be bumping up many times a day. People with OSA who have frequent adrenalin rushes at night can have a carry over through the day and it keeps you in a state of readiness for action and keeps the BP elevated. If you are a reactive type person-an anti hypertensive group of drugs called beta blockers may work better for you. If your control isn't good-you can add it to your other drugs or it can be substituted for one you are taking. Talk to your doc.

And BTW when you go to the docs leave home early and don't wear tight clothing-its the tight blue jean hypertension.

TXKajun · Post by **TXKajun** » Tue Oct 31, 2006 9:21 am

My BP is always a tad high at the start of my Dr. visit, usually about 135/90. After visiting with the nurse, relaxing a bit after initial BP test, my Dr. comes in, we chat for a bit, then he takes my BP again. Invariably, it's down into the normal range, about 120/75 or 125/80. I also check at home at irregular intervals and it's usually normal. Also, at Walmart, the machine there gives me high reading the first time. I sit for a bit, relax and it's down after about 10 minutes.

Kajun

This therapy WORKS!!!

sleepinsilly · Post by **sleepinsilly** » Tue Oct 31, 2006 10:58 am

Hi,

Here's a little first-hand advice. I have the same problem. Fortunately I have a really great regular m.d. who's a wonderful guy and a great doctor.

He's taught me a lot about BP over the years, and here it is: to properly take blood pressure, you need to sit quietly for 15 minutes before it's taken. So, often he gives me a magazine to read or just chats with me for awhile and then he takes it. And if he doesn't get a satifactory reading. he waits and takes it again. (I always tell him if he's going to make me get on the scale, then we need to do that AFTER the bp, ha, ha.) He usually ends up taking it 3 times before it comes down (because of the white coat thing. And this is a doctor I adore! But it doesn't matter)

Also, he bought a larger cuff for me, so if you're a large person, you might want to look into this.

He has a particular way of holding my arm while he takes it; he gets pretty close, takes my arm and sort of rests it against his side. He's always telling me to relax. I've never had anyone put my arm in quite this position, but it's very natural and it seems to work well.

For my part, I try to look at a painting on his wall and relax, or think about something relaxing. It's hard not to get anxious just thinking about having it taken, since I'm always worried it's going to be high. That's a double whammy!

He's great with this stuff and is smart enough to discount the # to where he believes it really is. He seems to know what's usual for me and discounts the systolic # by quite a bit.

Guest · Post by **Guest** » Tue Oct 31, 2006 11:59 am

I monitor my BP at home, too. Doctors' offices are often sloppy about taking BP. From what I've seen, dentists' offices are more careful. The cuff should be the right size. Your arm should be supported at the level of your heart. You shouldn't talk while the reading is being taking and they shouldn't talk to you, though they often do -- just hearing a voice will elevate your BP; this is normal. You should be calm and comfortable, not recently exercising, eating, hurrying, or driving, not needing to go to the bathroom. My GI doc said that just the stress of driving to the appointment could give a falsely high reading. The best readings I've had recently were taken at the sleep center and the oral surgeon's office. Of course, they weren't wearing white coats! LOL

PS: I've been taking a beta blocker for hypertension for several years (with undiagnosed sleep apnea). The beta blocker makes me feel dull and lethargic, and I just hate having to take it.

tohosa · Post by **tohosa** » Tue Oct 31, 2006 12:06 pm

I'm the previous Guest. I forgot to log in.

IBTeri · Post by **IBTeri** » Tue Oct 31, 2006 1:57 pm

I got one of those wrist one's that have up to 100 readings saved in memory. The doctor had me take mine in and show him and he did an average and used that instead of the one's in office cause I have white coat too.
lol but until I lost the weight I still need to take meds. now I don't after losing 60 lbs

krousseau · Post by **krousseau** » Tue Oct 31, 2006 3:04 pm

I'm not sure how long I went along the idea about white coat hypertension before I took a good look and decided that was the way I reacted in a lot of situations. Started taking my BP without trying to relax or do things to get a "good reading". I did it when angry or anxious or busy-because that was the way a lot of the day went in the work I was doing. My doc made light of it, "You don't want to take your BP then!" So I found a new doc and got on medications and learned to meditate.

BTW side effects-some of the beta blockers are sort of "broad range"-some are specific-the specific ones have fewer side effects.